The head says yes but the heart says no: what is non-cardiac chest pain and how is it managed?

Chambers, John; Marks, Elizabeth; Hunter, Myra

doi:10.1136/heartjnl-2014-306277

Cited by 29 publications

(39 citation statements)

References 89 publications

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“…Potential indications for need to avoid further cardiac diagnostic testing include residual pain after multiple negative investigations or reassuring recent coronary angiogram. 23 Notably, there are no established guidelines for sufficient exoneration of cardiac causes of persistent chest pain, but periodic future investigations in patients who have had previously negative workups are warranted, as some may come to develop underlying cardiac disease.…”

Section: Differential Diagnosismentioning

confidence: 99%

Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist

et al. 2017

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Background Patients presenting with chest pain to general practice or emergency providers represent a unique challenge, as the differential is broad and varies widely in acuity. Importantly, most cases of chest pain in both acute and general practice settings are ultimately found to be non-cardiac in origin, and a substantial proportion of patients experiencing non-cardiac chest pain (NCCP) suffer significant disability. In light of emerging evidence that mental health providers can serve a key role in the care of patients with NCCP, knowledge of the differential diagnosis, psychiatric co-morbidities, and therapeutic techniques for NCCP would be of great use to both consultation-liaison (C-L) psychiatrists and other mental health providers. Methods We reviewed prior published work on (1) the appropriate medical workup of the acute presentation of chest pain, (2) the relevant medical and psychiatric differential diagnosis for chest pain determined to be non-cardiac in origin, (3) the management of related conditions in psychosomatic medicine, and (4) management strategies for patients with NCCP. Results We identified key differential diagnostic and therapeutic considerations for psychosomatic medicine providers in 3 different clinical contexts: acute care in the emergency department, inpatient C-L psychiatry, and outpatient C-L psychiatry. We also identified several gaps in the literature surrounding the short-term and long-term management of NCCP in patients with psychiatric etiologies or co-morbid psychiatric conditions. Conclusions Though some approaches to the care of patients with NCCP have been developed, more work is needed to determine the most effective management techniques for this unique and high-morbidity population.

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Section: Differential Diagnosismentioning

confidence: 99%

Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist

et al. 2017

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“…Anxiety and emotional stress may lead to chest pain by causing increased muscle tension (32) or chronic activation of hypothalamic-pituitary-adrenal axis (33). In addition, the prevalences rates of anxiety and depression were found to be similar among individuals with a cardiac diagnosis and those diagnosed with NCCP (34,35). In accordance with these reports, our findings demonstrated that there were no significant differences in STAI I-II, HDRS, and CTQ-SF scores between ACP patients with NCCP and CCP.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between State-trait Anxiety and Childhood Trauma in Patients with Acute Chest Pain

Doğan¹

2019

Eurasian J Emerg Med

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“…Chest pain is a frequent symptom and may be caused by cardiac and noncardiac causes [1]. Especially in patients with multiple comorbidities, it is sometimes difficult to establish the correct diagnosis and therapy, as illustrated by the following case.…”

Section: Introductionmentioning

confidence: 96%

Hemopericardium under dabigatran for stroke prevention in atrial fibrillation

Stöllberger

Heger

Finsterer

2017

Blood Coagulation &Amp; Fibrinolysis

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Spontaneous hemopericardium is a complication of anticoagulant therapy with not only vitamin-K-antagonists, but also with nonvitamin-K-antagonist oral anticoagulants. We report a polymorbid 75-year old male under a therapy with dabigatran, valsartan, amlodipine, nicorandil, furosemide, atorvastatin, bisoprolol, metformin, tizanidine, pantoprazole, and tramadol. He suffered from chest pain for 4 months. Coronary angiography showed only ectatic coronary arteries. He started taking nonsteroidal anti-inflammatory drugs. He was hospitalized because of dyspnea starting 10 days before admission, melena, and renal failure. Hemopericardium was diagnosed and pericardiocentesis yielded 2000 ml hemorrhagic fluid. Review of previous echocardiograms showed a 4 mm echo-free space, epicardial fat or pericardial effusion. A small (<10 mm) echo-free space in a patient on anticoagulant therapy should not be considered as trivial, but additional imaging studies should be carried out. If a pericardial effusion is newly diagnosed in a patient during anticoagulant therapy, the pharmacotherapy should be revised concerning potentially interacting drugs, like nonsteroidal anti-inflammatory drugs, and dosage of the anticoagulant drug. Vitamin-K-antagonists with their possibility of laboratory monitoring and availability of an antidote should be preferred over nonvitamin-K-antagonist oral anticoagulants.

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The head says yes but the heart says no: what is non-cardiac chest pain and how is it managed?

Cited by 29 publications

References 89 publications

Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist

Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist

The Relationship Between State-trait Anxiety and Childhood Trauma in Patients with Acute Chest Pain

Hemopericardium under dabigatran for stroke prevention in atrial fibrillation

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